CARDIO PULMONARY RESUSCITATION AND BASIC LIFE SUPPORT

Dr Sarika Gupta (MD,PhD); Asst. Professor

1. BLS 2. CPR 3. BLS Sequences 4. Bag and mask ventilation 5. Defibrillation

BASIC LIFE SUPPORT

Cardac arrest : a substantial public health problem

: a leading cause of death For best survival and quality of life, pediatric

basic life support (BLS) should be part of a community effort

Rapid and effective bystander CPR can be associated with successful return of spontaneous circulation (ROSC) and neurologically intact survival in children following out-of-hospital cardiac arrest

BASIC LIFE SUPPORT

Sequences of procedures performed to restoe the circulation of oxygenated blood after a sudden pulmonary/cardiac arrest

Chest compressions and pulmonary ventilation performd by anyone who knows how to do it, anywhere, immediately, without any other equipment

CARDIO PULMONARY RESUSCITATION

Combines rescue breathing and chest compressions

Revives heart and lung functioning

High Quality CPR

A compression rate of at least 100/min PUSH FAST

A compression depth of at least 4 cm in infants and 5 cm in children PUSH HARD

Alloing complete chest recoil, minimizing interruptions in compressions and avoiding excessive ventilation

For best results, deliver chest compressions on a firm surface

BASIC LIFE SUPPORT

Pediatric Chain of Survival

Prevention of arrest

Early high quality bystander CPR

Rapid activation of EMS

Early ALS Integrated post- cardiac arrest care

ABC or CAB?

The recommended sequence of CPR has previously been known by the initials “ABC”: Airway, Breathing/ventilation, and Chest compressions (or Circulation).

The2010 AHA Guidelines for CPR and ECC recommend a CAB sequence (chest compressions, airway, breathing/ventilations) cardiac arrest

ABC or CAB?

During cardiac arrest high-quality CPR, particularly high-quality chest compressions are essential to generate blood flow to vital organs and to achieve ROSC

Starting CPR with 30 compressions followed by 2 ventilations should theoretically delay ventilations by only about 18 seconds for the lone rescuer and by an even a shorter interval for 2 rescuers.

The CAB sequence for infants and children is recommended in order to simplify training with the hope that more victims of sudden cardiac arrest will receive bystander CPR

BLS/CPR sequence

1. Safety of Rescuer and Victim 2. Check for Response and breathing If the victim is unresponsive and not breathing

(or only gasping), shout for help If the child collapsed suddenly and you are alone,

leave the child to activate the EMS and get the AED

3. Check the child’s pulse (5-10 seconds) CAROTID/FEMORAL/ Brachial artery in infants

If, within 10 seconds, you don't feel a pulse or are not sure if you feel a pulse, begin chest compressions 

BLS/CPR sequence

Inadequate Breathing With Pulse : If there is a palpable pulse ≥60 per minute but there is inadequate breathing, give rescue breaths at a rate of about 12 to 20 breaths per minute (1 breath every 3 to 5 seconds) until spontaneous breathing resumes. Reassess the pulse about every 2 minutes

If the pulse is <60 per minute and there are signs of poor perfusion (ie, pallor, mottling, cyanosis) despite support of oxygenation and ventilation, begin chest compressions

BLS/CPR sequence

4. CPR : The lone rescuer- cycle of 30 compressions and 2

breaths for approximately 2 minutes (about 5 cycles)

Two rescuer- cycle of 15 compressions and 2 breaths

5. Activate Emergency Response System After 5 cycles, if someone has not already done

so, activate the emergency response system and obtain an automated external defibrillator (AED)

BLS/CPR sequence

For an infant, lone rescuers (whether lay rescuers or healthcare providers) should compress the sternum with 2 fingers placed just below the intermammary line

BLS/CPR sequence

 The 2-thumb–encircling hands technique: recommended when CPR is provided by 2 rescuers.

Encircle the infant's chest with both hands; spread your fingers around the thorax, and place your thumbs together over the lower third of the sternum

BLS/CPR sequence

It produces higher coronary artery perfusion pressure, results more consistently in appropriate depth or force of compression and may generate higher systolic and  diastolic pressures

BLS/CPR sequence

For a child, lay rescuers and healthcare providers should compress the lower half of the sternum at least one third of the AP dimension of the chest or approximately 5 cm (2 inches) with the heel of 1 or 2 hands

BLS/CPR sequence

Opening the aiwray : In an unresponsive infant or child, the tongue

may obstruct the airway and interfere with ventilations. Open the airway using a head tilt–chin lift maneuver

BLS/CPR sequence

Breaths : To give breaths to an infant, use a mouth-to-

mouth-and-nose technique To give breaths to a child, use a mouth-to-mouth

technique.  Make sure the breaths are effective (ie, the

chest rises). Each breath should take about 1 second. If the chest does not rise, reposition the head, make a better seal, and try again

Bag and Mask Ventiltion

Bag-mask ventilation is an essential CPR technique for healthcare providers 

Bag-mask ventilation requires training in the following skills: selecting the correct mask size, opening the airway, making a tight seal between the mask and face, delivering effective ventilation, and assessing the effectiveness of that ventilation

Use a self-inflating bag with a volume of at least 450 to 500 mL for infants and young children

In older children or adolescents, an adult self-inflating bag (1000 mL) may be needed to reliably achieve chest rise

Bag and Mask Ventiltion

To deliver a high oxygen concentration (60% to 95%), attach an oxygen reservoir to the self-inflating bag

Maintain an oxygen flow of 10 to 15 L/min into a reservoir attached to a pediatric bag and a flow of at least 15 L/min into an adult bag

Bag-mask ventilation can be provided effectively during 2-person CPR

Bag and Mask Ventiltion

Effective bag-mask ventilation requires a tight seal between the mask and the victim's face.

Open the airway by lifting the jaw toward the mask making a tight seal and squeeze the bag until the chest rises

Defibrillation

VF and pulseless VT are referred to as “shockable rhythms” because they respond to electric shocks (defibrillation).

For infants a manual defibrillator is preferred If a manual defibrillator is not available, an AED

equipped with a pediatric attenuator is preferred for infants.

Defibrillation

An AED with a pediatric attenuator is also preferred for children <8 year of age. If neither is available, an AED without a dose attenuator may be used

The recommended first energy dose for defibrillation is 2 J/kg. If a second dose is required, it should be doubled to 4 J/kg

Defibrillation

Defibrillation Sequence Using an AED Turn the AED on Follow the AED prompts End CPR cycle (for analysis and shock) with

compressions, if possible Resume chest compressions immediately after

the shock. Minimize interruptions in chest compressions

Summary

For best survival and quality of life, pediatric basic life support (BLS) should be part of a community effort

Rapid and effective bystander CPR